ECT benefits demonstrated in randomised controlled trial

Abstract

medwireNews: Electroconvulsive therapy (ECT) is more effective than pharmacological treatment for the reduction of depressive symptoms in patients with treatment-resistant bipolar depression, Norwegian study data show.

However, “[r]emission rates remained modest regardless of treatment choice for this challenging clinical condition”, remark lead researcher Helle Schoeyen (Stavanger University Hospital) and co-authors in TheAmerican Journal of Psychiatry.

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The randomised controlled trial, believed to be the first of its kind in this setting, compared efficacy of ECT with that of algorithm-based pharmacological treatment in 66 patients with treatment-resistant bipolar depression who were being cared for at seven acute-care psychiatric inpatient clinics throughout Norway.

Patients randomly assigned to ECT (n=36) received the treatment three times per week for up to 6 weeks, with right unilateral placement of stimulus electrodes according to the d’Elia method and brief pulse stimulation. Those in the pharmacological group (n=30) were treated according to the Goodwin and Jamison treatment algorithm for bipolar depression.

Baseline variables such as age, gender, illness duration, number of episodes and scores on symptom rating scales, did not differ significantly between the groups.

However, at the end of the 6-week treatment period, the mean Montgomery-Åsberg Depression Rating Scale (MADRS) score was a significant 6.6 points lower in the ECT group than in the pharmacological treatment group, indicating that ECT was significantly more effective than algorithm-based pharmacological treatment.

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Similarly significant differences were observed for the secondary outcome measures of the 30-item Inventory of Depressive Symptomatology–Clinician Rated and the Clinical Global Impressions Scale for Bipolar Disorder, with scores 9.4 and 0.7 points lower, respectively, for ECT than for pharmacological treatment.

Among patients who completed treatment, the response rate – defined as a decrease in MADRS score of at least 50% from baseline – was significantly higher in the ECT group, at 73.9% (17 of 23 patients), than in the pharmacological treatment group, at 35.0% (seven of 20).

Schoeyen et al remark that the fact that nearly three-quarters of patients responded to ECT should be considered “a relatively successful outcome in this cohort of ill patients”.

By contrast, the remission rate – defined as a MADRS score of 12 or lower – was low and did not differ significantly between the two groups, at 34.8% for ECT versus 30.0% for pharmacological treatment.

This finding highlights “the need for research focusing on the detection of new and more effective treatment options for treatment-resistant bipolar depression”, Schoeyen and co-authors conclude.